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D S Seidman

Publications and source records attributed to D S Seidman.

At least 73 records · Page 4Linked to original sources
PubMed1997

Laparoscopic management of pelvic pathology during pregnancy.

Advanced operative laparoscopy is being performed increasingly for various indications and in diverse patient populations, including gravid women. In the United States approximately 1.6% to 2.2% of pregnant women require nonobstetric surgery for abdominal and pelvic pathology. Increasing numbers of case reports suggest the feasibility and safety of operative laparoscopy during pregnancy. We identified certain management issues specific to these procedures based on our experience with nine cases of operative laparoscopy in women with gestations up to 22 weeks.

Female↗
PubMed1997

Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock.

STUDY OBJECTIVE: To determine the safety of operative laparoscopy in the management of ectopic pregnancy in women with hypovolemic shock. DESIGN: Retrospective chart review. SETTING: University-affiliated hospital. PATIENTS: Two hundred eleven women with tubal pregnancy, of whom 33 were suffering from hypovolemic shock, based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Mean +/- SEM intraabdominal blood loss was significantly (p <0.01) higher in women with hypovolemic shock, 1369 +/- 149 versus 114 +/- 14 ml. Blood transfusions were given to 88% and 0.5%, respectively (p <0. 01). Laparoscopic salpingectomy was performed in all hemodynamically compromised women compared with 87% of stable women. Conversion to laparotomy was required in three patients in the hypovolemic shock group and five in the stable group. All patients had an uncomplicated postoperative course and made a full recovery. CONCLUSION: The availability of optimal anesthesia and advanced cardiovascular monitoring, and the ability to convert rapidly to laparotomy if required, allow safe performance of operative laparoscopic surgery in most women in hypovolemic shock. In fact, the superior exposure of laparoscopy, providing rapid diagnosis and control of the source of bleeding, makes it a highly suitable approach.

Adult↗
PubMed1997

Incisional hernias after operative laparoscopy.

The objective of this study was to determine the possible risk factors of incisional hernias after operative laparoscopy. A retrospective case review was performed in a single referral obstetrics/gynecology clinic and center for special pelvic surgery considering the last 5300 surgeries. Of the approximately 5300 patients who underwent laparoscopy from January 1988 through June 1996, 10 women were evaluated for incisional hernias. A total of 11 hernias occurred, which is an incidence of approximately 0.2%. Omentum herniated in seven cases and bowel herniated in four cases. In one case, the sigmoid epiploica irreducibly herniated through the peritoneum and not the fascia. The hernia occurred through a 5-mm trocar incision site in five cases. The median duration of the laparoscopic surgeries was 192 minutes (range, 25-375 minutes). Six women required laparoscopic surgery in order to retract the entrapped omentum or bowel. In one case, laparoscopically assisted bowel resection was necessary. The underlying fascia and peritoneum should be closed not only when using trocars of 10 mm and larger as previously suggested but also when extensive manipulation is performed through a 5-mm trocar port, causing extension of the incision.

Adult↗
PubMed1997

Major retroperitoneal vascular injury during laparoscopic surgery.

We sought to assess the outcome of large retroperitoneal vascular injury that occurred during operative laparoscopy but was not related to trocar or Veress needle injury. We conducted a retrospective review of cases operated and reviewed by our centres. Eight cases were identified. Four women were undergoing lymphadenectomy, where vascular injury is a recognized risk. Distorted anatomy was a compounding factor in three of the remaining four patients who were undergoing intraperitoneal procedures. The injuries involved the inferior vena cava (n = 2), the right external iliac artery (n = 2), the left external iliac artery (n = 1), the right external iliac vein (n = 1), the hypogastric artery (n = 1) and the inferior mesenteric artery (n = 1). Injuries were caused by unipolar electrode (n = 1), electrosurgical scissors (n = 3), sharp scissors (n = 2) and CO(2) laser (n = 2). The vessel injury was repaired at laparotomy in four women. The other four cases were managed laparoscopically. Transfusion attributable to the vascular injury occurred in two cases. The outcome in all cases was good, except for one in which the patient died. These cases demonstrate that all energy sources used without proper understanding and caution can cause significant vascular injury. The adequacy and safety of laparoscopic control of major vessel bleeding should be investigated further and consultation with a vascular surgeon should be considered in all cases.

Adult↗
PubMed1997

Gynecologic operative laparoscopy: new training programs are needed.

The revolution in laparoscopic surgery demands implementation of adequate training programs preferably in an academic setting. The most dramatic progress over the last decade in the field of gynecology was undoubtedly the development of advanced operative laparoscopy. This has been initiated by an unprecedented technological revolution.

Journal Article↗
PubMed1997

Prevalence of antibodies to cytomegalovirus in a parturient population in Israel.

The aim of our study was to assess the serologic immunity to cytomegalovirus (CMV) in a population of pregnant women in Israel. We measured the titers of both IgG and IgM to CMV in 6,126 pregnant women by enzyme immunoassay. Of these, 84.3% were found to be positive for anti-CMV IgG and 15.7% were seronegative, and thus susceptible to primary infection. The total number of women positive for anti-CMV IgM, and hence suspected of being infected with the virus during or shortly before their pregnancy, was 43 (0.7%). An acute infection was therefore diagnosed in 4.35% of IgG seronegative women. A significantly higher CMV seropositivity rate was found in the parturient population as compared to surveys conducted in Israel in the 1970's. The seropositivity rates found in Israel are similar to those reported in Asia and Africa. The rate of serosusceptibility and the risk of primary CMV infection in pregnancy are lower in Israel than in Europe and North America. According to the observed incidence of primary CMV infection in pregnant women, it can be estimated that approximately 280 cases of fetal infection occur in Israel every year, potentially resulting in 56 symptomatic newborns.

Adult↗
PubMed1996

Primary peritoneal serous papillary carcinoma: a study of 25 cases and comparison with stage III-IV ovarian papillary serous carcinoma.

The clinical characteristics and treatment outcome of patients with primary peritoneal serous papillary carcinoma (PPSC) (n = 22) was compared with stage III-IV papillary serous ovarian carcinoma (PSOC) patients (n = 63). There were no statistically significant differences between the PPSC and PSOC patients with regard to the mean age, menopausal status, parity, ascites fluid volume, proportion of stage IV disease, and the rate of optimal debulking achieved. The median disease-free interval was 15 and 18 months; the median survival was 21 and 26 months; and the 5-year survival was 18 and 24% for the PPSC and PSOC groups, respectively. The median survival time for patients with a residual tumor > or = 2 cm was 20.5 and 24 months, and for residual tumor > or = 2 cm was 46 and 41 months, in PPSC and PSOC patients, respectively. Survival was thus better, in both groups, when residual disease at the end of the operation was < 2 cm, though this was statistically significant only for PSOC (P < 0.02). We conclude that patients with PPSC should be treated as other stage II-IV PSOC patients. Combining optimal debulking with a platinum-based chemotherapy may offer the patient the most effective treatment.

Aged↗
PubMed1996

Delayed recognition of iliac artery injury during laparoscopic surgery.

Vascular injury is one of the major complications of laparoscopic surgery. Prompt diagnosis is crucial for proper management of this potentially life-threatening complication. Two cases of iliac artery puncture occurred during operative laparoscopy. The injuries were not diagnosed immediately, probably due to the initial accumulation of blood in the retroperitoneum. Significant damage to large blood vessels may not be readily apparent during laparoscopic surgery.

Adult↗
PubMed1996

Early oral feeding after cesarean delivery.

OBJECTIVE: To assess the gastrointestinal function and patient acceptability of early initiation of oral feeding after cesarean delivery. METHODS: Two hundred twenty-one healthy women delivered by cesarean were assigned in an alternating manner to receive either a high-protein, low-residue pudding initiated within 6 hours of delivery and given every 6 hours thereafter (n = 108), or a standard postoperative diet, consisting of sips of water 12 hours after surgery and a liquid diet permitted only after bowel sounds returned and flatus passed (n = 113). RESULTS: Compared with the control group, the early-feeding group had a shorter mean (+/- standard deviation) duration of intravenous fluid administration, 18.6 +/- 6.3 versus 30.5 +/- 8.1 hours (P < .001); more rapid return to regular oral diet, 26.8 +/- 6.3 versus 39.7 +/- 8.8 hours (P < .001); and a shorter time to first bowel movement, 30.0 +/- 10.0 versus 43.3 +/- 11.7 hours (P < .001). There was no significant increase in gastrointestinal morbidity: 17.4 versus 15.6%, respectively. CONCLUSION: Early feeding after cesarean delivery was well tolerated and was associated with a more rapid return to a normal diet. This approach may facilitate early hospital discharge.

Adult↗
PubMed1996

The effect of intracervical vasopressin on the systemic absorption of glycine during hysteroscopic endometrial ablation.

OBJECTIVE: To examine the effect of paracervical injection of vasopressin on the absorption of glycine during transcervical endometrial ablation. METHODS: Thirty-three consecutive women scheduled for elective hysteroscopic endometrial ablation were randomized to either the study or control group. All procedures were performed with a myoma resectoscopy using 1.5% glycine as the irrigating medium at a flow rate of 100 mL/minute. In the study group, a solution of 0.2 mg vasopressin diluted with 20 mL saline was injected paracervically. Blood samples were obtained through an indwelling intravenous catheter every 5 minutes until the completion of the operation. Serum sodium, potassium, and magnesium levels were measured at 20-minute intervals. In addition, glycine concentrations were determined by both rapid screening and quantitative amino acid analysis. RESULTS: Plasma glycine maximal concentrations were significantly lower (P < .001) in patients who received vasopressin, compared with controls (8.8 +/- 4.5 versus 16.0 +/- 6.3 mmol/L, respectively). The calculated extent of glycine absorption within the first 20 minutes of the procedure was 59.6 +/- 30.0 versus 179.8 +/- 66.2 mmol/L.minute in the study and control groups, respectively (P < .001). The differences in plasma sodium, potassium, and magnesium levels were not significant. CONCLUSION: Intracervical vasopressin administration significantly decreased systemic glycine absorption in patients undergoing hysteroscopic endometrial ablation.

Absorption↗
PubMed1996

Hyperechogenic fetal bowel and elevated serum alpha-fetoprotein: a poor fetal prognosis.

OBJECTIVE: To evaluate the clinical significance of increased fetal bowel echogenicity in women with elevated maternal serum alpha-fetoprotein (MSAFP) during the second trimester. METHODS: The study group comprised six pregnant women with elevated second-trimester MSAFP (greater than 2.5 multiples of the median), whose ultrasonographic evaluations indicated hyperechogenic fetal bowel. They were compared with six pregnant women whose fetuses, during routine second-trimester ultrasonographic screening for fetal anomalies, were found to have a hyperechogenic bowel without elevated MSAFP, according to natural history, pregnancy outcome, and associated features. RESULTS: All six fetuses with the combination of elevated MSAFP and echogenic bowel were growth-restricted; four died in utero and one of the two live-born infants died during the neonatal period. The single survivor in this group was born prematurely; necrotizing enterocolitis was diagnosed at 30 days of life and surgery was performed. None of the cases had associated congenital anomalies. Only one of the six controls had associated anomalies (trisomy 21), and this pregnancy was terminated. The pregnancy course of the remaining five fetuses was normal; all were appropriate for gestational age and were delivered at term. No perinatal mortality occurred in this group; however, in one infant, cerebral palsy was diagnosed at 10 months of age. CONCLUSION: Fetal bowel hyperechogenicity found in women with elevated second-trimester MSAFP levels is associated with poor fetal outcome, particularly fetal growth restriction with fetal and neonatal death, and should be considered an ominous prenatal finding.

Adult↗
PubMed1996

The risk of carbon monoxide poisoning after prolonged laparoscopic surgery.

OBJECTIVE: To evaluate whether thermal energy produced by laser and bipolar electrosurgery during laparoscopic procedures significantly elevates blood carboxyhemoglobin levels. METHODS: We prospectively studied 27 healthy nonsmoking patients, mean +/- standard deviation (SD) age 39.1 +/- 8.0 years (range 22-56), scheduled for laparoscopic procedures in which smoke was generated. Prolonged operative laparoscopy involved high-flow carbon dioxide insufflation, intensive evacuation of intra-abdominal smoke, and controlled hyperventilation with 50-100% oxygen. Laser and bipolar electrosurgery were used in all cases. Blood samples were drawn before and after surgery. Carboxyhemoglobin concentrations were measured using a highly accurate gas chromatography method. RESULTS: The mean +/- SD duration of surgery was 141 +/- 72 minutes (range 45-300). The mean +/- SD carboxyhemoglobin levels were 0.70 +/- 0.15% (range 0.44-1.20%) before surgery and 0.58 +/- 0.20% (range 0.30-1.33%) after surgery. A significant decrease (P < .001) in carboxyhemoglobin concentrations occurred during surgery (mean +/- SD, 20 +/- 11%; range 3-46%). The carboxyhemoglobin level was increased at the end of surgery in only one woman. In only one patient did the levels exceed 1% (1.33%), still well below the human threshold tolerance level of 2%. The Spearman correlation coefficient between carboxyhemoglobin concentrations and duration of surgery was r = 0.308 (P = .12). CONCLUSION: Carbon monoxide (CO) poisoning is not associated with even prolonged laparoscopic surgical procedures. This may be attributed to aggressive smoke evacuation that minimizes exposure to CO, and to active elimination of CO by ventilation with high oxygen concentrations.

Adult↗
PubMed1996

Laparoscopic trachelectomy for persistent pelvic pain and endometriosis after supracervical hysterectomy.

OBJECTIVES: To discuss the safety of laparoscopic removal of the cervical stump after supracervical hysterectomy. DESIGN: Retrospective review of six cases. SETTING: Center for Special Pelvic Surgery, a tertiary referral center. PATIENT(S): Between August 1993 and December 1995, six patients underwent laparoscopic removal of the cervical stump. Their mean age was 43.1 years (range 32 to 56 years). All women had pelvic pain, and one had abnormal bleeding. Three patients had histories of severe endometriosis only, one had extensive endometriosis with adhesions, one had severe adhesions and leiomyomas, and one had all three conditions at hysterectomy. INTERVENTION(S): Laparoscopic trachelectomy. MAIN OUTCOME MEASURE(S): Laparoscopic findings and intraoperative and postoperative complications. RESULT(S): The mean blood loss was 100 mL (range 50 to 200 mL). There were no major intraoperative or postoperative complications. CONCLUSION(S): Cervical stump removal can be accomplished laparoscopically by an experienced surgeon.

Adult↗
PubMed1996

Prenatal ultrasonographic diagnosis of fetal hydrocephalus due to infection with parainfluenza virus type 3.

Parainfluenza virus type 3 is one of the most common causes of respiratory infection in infants. No complications of pregnancy or fetal anomalies have been reported in association with parainfluenza virus infection. A pregnancy was terminated at 22 weeks' gestation due to ultrasonographic diagnosis of hydrocephalus. Pathological examination was consistent with viral encephalitis, ventriculitis and pneumonia. Serological investigation demonstrated a significant rise in maternal antibody titers for parainfluenza virus type 3. Parainfluenza virus type 3 may be associated with severe fetal infection in the first half of pregnancy. Serological studies for this virus should be considered in cases of fetal hydrocephalus.

Abortion, Therapeutic↗
PubMed1996

Prenatal ultrasonographic diagnosis of fetal hepatic hyperechogenicities: clinical significance and implications for management.

The clinical significance of sonographically detected fetal hepatic hyperechogenicities has not been fully established. The aim of this study was to assess various aspects of fetal hepatic hyperechogenicities detected in utero, including natural history, prenatal investigation and pregnancy outcome. In a retrospective survey of pregnant women presenting to the ultrasonographic unit, five fetuses with a mean gestational age of 20 weeks (range 14-24 weeks) were antenatally diagnosed as having hepatic hyperechogenicities. All cases underwent extensive investigation to establish the etiology and to determine the spectrum of ultrasonographic presentation. In three fetuses, only parenchymal lesions were found, while two had combined lesions: parenchymal and peritoneal. The earliest prenatal ultrasonographic diagnosis was made at 14 weeks' gestation in a fetus with combined hyperechogenic lesions, which, at 12 weeks' gestation, demonstrated unexplained fetal ascites. Associated abnormalities were found in only one fetus in which a solitary parenchymal lesion was associated with direct communication of the intrahepatic portion of the umbilical vein with the right atrium, and high output cardiac failure. In this case, termination of pregnancy confirmed ischemic hepatic necrosis. In the other four cases, no direct etiology could be determined, and all four pregnancies continued to term with normal neonatal follow up until 12 months of age. The present data suggest that in cases of fetal hepatic hyperechogenicities, where apparent intrauterine infection or neoplasia can be ruled out, a vascular disruption phenomenon is a putative etiology. If there are no associated morphological abnormalities or abnormal karyotypes, the prognosis may be favorable.

Adult↗